The National Health Service breast screening programme (NHSBSP) was introduced in 1988 with the
aim to decrease the incidence and mortality rate of breast cancer (1). Mammography is the primary
diagnostic tool of the NHSBP and is offered to women every 3 years (2). Originally screening was
available to woman aged 50-64, this was extended to 50-70 in 2003. In England a further extension
to the screening age is being rolled out (47-73, (1). The extension of the effective age bracket makes
it vital that that the programme is effective. ,This report will evaluate the cost of implementation,
the radiation dose and psychological factor effecting the participants in the NHSBSP. The report will
also discuss the development of equipment and changes in mortality attributable to screening. 110 1) The cost of implementation of such a screening programme; this may be a financial or a human resource cost Latest information from the NHSBSP estimates the cost at £96 million per annum (3). The Forrest report recommend that a basic screening unit serve a population area of 471 000 people, of this number some 41 150 people were aged within the 50-64 bracket. If one assumes the required 70% attendance this gives rise to some 12000 estimated screening sessions per year (4). However, these figures apply numbers taken before the screening age was extended. Smaller screening programmes are less cost effective and result is a greater number of referrals (5). Staffing requirements state that there must be a director of breast screening, programme management and clinical management. A multi-disciplinary team must be formed which must be attended by a radiologist and a pathologist experienced with breast biopsies (5). Mammograms must be undertaken by an appropriately trained professional under Ionising Radiation (Medical Exposure) Regulations ‘(IR(ME)R)’ 2000, this may be an appropriately trained radiographer or assistant practitioner (6). Tomosynthesis is not currently widely accepted as a diagnostic tool at present, however it may be used particular circumstances using the Hologic Selenia Dimensions digital breast tomosynthesis system (7). Radiographers are required to undergo vendor specific training, to understand the technology and to ensure their ability to test quality control of screenings. Radiologists should attend lectures on the specific technological requirements and review a minimum of 80 cases, 40 of which should be assessed by the radiologist responsible for training (7). The amount of resources used by the NHSBSP is a large amount, however it does remain cost effective. Screening was associated with 2040 quality adjusted life year (QALY) at a cost of £20,800 per QALY (8). QALY is a measurement of disease burden, based on quantity and quality of life (9). 213 2) Radiation Dose; examine the risk as a result of radiation exposure compared to the benefit of detecting pathology (consider screening over a lifetime and risk factors for breast cancer). The diagnostic reference level for Full field digital Mammography (FFDM) is 3.5mGy per 50-60mm of tissue thickness (7). Yaffe and Mainprize (10) calculated that 86 cases of radiation induced cancer resulting in 11 fatalities per 100,000 women screened annually, between 40-55 and biennially 620028819 PAM2006 between 55 and 74. This number would be significantly reduced within the NHSBSP as women undergo routine screening …show more content…
367
3) The psychological impact of screening; include discussion of false positives and false
negatives, unnecessary interventions and barriers to patients taking up screening
It has been demonstrated that false positives have a short-term effect on women’s anxiety and
cancer fears - see Tyndel et al. (18). This study measured women’s cancer worries one month prior
to mammographic screening as again at one month and six months post screening. They found at 1-
month post screening women who had received all clear had significantly lower levels of cancer
worry compared to recalled women. However, at the 6 month questionnaire there was no significant
difference between cancer worry levels. However, Meta-analysis has illustrated that false positives
can influence a patient’s likelihood to return for screening at a later point by either increasing or
decreasing that chance. It also suggests that false positives may increase the chance of breast self-
examination (19), which may increase detection of interval cancers (20)
620028819 PAM2006
False positives may be recalled for biopsy. Thematic analysis of women’s experiences
aim to decrease the incidence and mortality rate of breast cancer (1). Mammography is the primary
diagnostic tool of the NHSBP and is offered to women every 3 years (2). Originally screening was
available to woman aged 50-64, this was extended to 50-70 in 2003. In England a further extension
to the screening age is being rolled out (47-73, (1). The extension of the effective age bracket makes
it vital that that the programme is effective. ,This report will evaluate the cost of implementation,
the radiation dose and psychological factor effecting the participants in the NHSBSP. The report will
also discuss the development of equipment and changes in mortality attributable to screening. 110 1) The cost of implementation of such a screening programme; this may be a financial or a human resource cost Latest information from the NHSBSP estimates the cost at £96 million per annum (3). The Forrest report recommend that a basic screening unit serve a population area of 471 000 people, of this number some 41 150 people were aged within the 50-64 bracket. If one assumes the required 70% attendance this gives rise to some 12000 estimated screening sessions per year (4). However, these figures apply numbers taken before the screening age was extended. Smaller screening programmes are less cost effective and result is a greater number of referrals (5). Staffing requirements state that there must be a director of breast screening, programme management and clinical management. A multi-disciplinary team must be formed which must be attended by a radiologist and a pathologist experienced with breast biopsies (5). Mammograms must be undertaken by an appropriately trained professional under Ionising Radiation (Medical Exposure) Regulations ‘(IR(ME)R)’ 2000, this may be an appropriately trained radiographer or assistant practitioner (6). Tomosynthesis is not currently widely accepted as a diagnostic tool at present, however it may be used particular circumstances using the Hologic Selenia Dimensions digital breast tomosynthesis system (7). Radiographers are required to undergo vendor specific training, to understand the technology and to ensure their ability to test quality control of screenings. Radiologists should attend lectures on the specific technological requirements and review a minimum of 80 cases, 40 of which should be assessed by the radiologist responsible for training (7). The amount of resources used by the NHSBSP is a large amount, however it does remain cost effective. Screening was associated with 2040 quality adjusted life year (QALY) at a cost of £20,800 per QALY (8). QALY is a measurement of disease burden, based on quantity and quality of life (9). 213 2) Radiation Dose; examine the risk as a result of radiation exposure compared to the benefit of detecting pathology (consider screening over a lifetime and risk factors for breast cancer). The diagnostic reference level for Full field digital Mammography (FFDM) is 3.5mGy per 50-60mm of tissue thickness (7). Yaffe and Mainprize (10) calculated that 86 cases of radiation induced cancer resulting in 11 fatalities per 100,000 women screened annually, between 40-55 and biennially 620028819 PAM2006 between 55 and 74. This number would be significantly reduced within the NHSBSP as women undergo routine screening …show more content…
367
3) The psychological impact of screening; include discussion of false positives and false
negatives, unnecessary interventions and barriers to patients taking up screening
It has been demonstrated that false positives have a short-term effect on women’s anxiety and
cancer fears - see Tyndel et al. (18). This study measured women’s cancer worries one month prior
to mammographic screening as again at one month and six months post screening. They found at 1-
month post screening women who had received all clear had significantly lower levels of cancer
worry compared to recalled women. However, at the 6 month questionnaire there was no significant
difference between cancer worry levels. However, Meta-analysis has illustrated that false positives
can influence a patient’s likelihood to return for screening at a later point by either increasing or
decreasing that chance. It also suggests that false positives may increase the chance of breast self-
examination (19), which may increase detection of interval cancers (20)
620028819 PAM2006
False positives may be recalled for biopsy. Thematic analysis of women’s experiences